





















&hne SPiudu 


NURSING 

SERVICES 

♦ 



^ SMALL 

MANUFACTURING 

PLANTS 





FEDERAL SECURITY AGENCY 
Public Health Service 























A Time Study 


NURSING SERVICES 
in Small 

Manufacturing Plants 


Eleanor C. Bailey, R.N., B.S. 

IV 

Elizabeth S. Frasier, Litt. B., Statistician 
« 

Division of Occupational Health 



FEDERAL SECURITY AGENCY 
Public Health Service 






. 6 ^ 




Public Health Service Publication No. 190 
Washington: 1952 


FOREWORD 


In discharging its primary responsibility— 
the promotion and maintenance of the health of 
the nation's workers—the Division of Occupational 
Health of the Public Health Service utilizes the 
knowledge and skills of a variety of specialized 
personnel. The medical, engineering, chemical, 
toxicological, statistical, and nursing professions 
are among those contributing greatly to the work 
of this Division. 

Nursing consultants, upon request, make 
available to State industrial hygiene agencies, 
educational institutions, industries, and industrial 
nurses, their background of training in, and ex¬ 
perience with, worker health problems. They 
assist in the preparation of educational materials 
and numerous research studies. 

An increasingly urgent need, in recent years, 
has been for the development of information as 
to the amount of nursing service required in 
industry. The need for such information has been 
increased by the demands of the defense program, 
which have accentuated the shortage of nurses. 

To augment available data on this subject, the 
present study was undertaken in cooperation with 
the Division of Public Health Nursing of the Public 
Health Service. The data here presented, although 
quite significant, indicate that further research is 
needed, and it is hoped that additional studies will 
be made which will pave the way for better utili¬ 
zation of nursing personnel in the field of occu¬ 
pational health. 


Seward E, Miller, Medical Director 
Chief, Division of Occupational Health 


111 


AC KNOWLODGMENTS 


Appreciation is expressed to members of the 
Advisory Committee who assisted in planning the 
study. The committee was composed of V. P. Ahearn, 
Executive Secretary, National Sand and Gravel As¬ 
sociation; Catherine Chambers, Industrial Advisory 
Nurse, Industrial Hygiene Division, Wisconsin State 
Board of Health, representing the American Nurses' 
Association; Mary E. Delehanty, past president, 
American Association of Industrial Nurses; 

Joanna M, Johnson, Director, Industrial Nursing 
Division, Employers Mutual Insurance Company; 

Mary M. Maher, Supervisor, Part-time Industrial 
Nursing Service, Visiting Nurse Service of New 
York, representing the National Organization for 
Public Health Nurses; and Harry Read, Executive 
Assistant to Secretary-Treasurer, Congress of 
Industrial Organizations. 

We wish, also, to thank management, physicians, 
and nurses in the plants where the study was con¬ 
ducted, and the personnel of the industrial hygiene 
bureaus. State departments of health, for their 
^lendid cooperation, 

\ 


IV 


DEFINITIONS 


1. Direct nursing services shall include those 

services which are provided for an employee, 

and may be listed as follows: 

a. Nursing care for industrial injuries and 
illnesses 

b. Nursing care for nonindustrial injuries 

c. Nursing care for medical complaints such 
as headache, colds, upset stomachs, and 
others 

d. Interview regarding a health problem when 
no treatment is given, but care is directed 
toward health guidance 

e. Immunizations 

f. Health examinations, which shall include that 
part of the examination delegated by the 
examining physician to the nurse, and may 
include such activities as obtaining health 
and occupational histories, vision testing, 
collection of laboratory specimens, and 
follow-up on physical findings 

g. Home nursing, which shall include visits to 
the homes of employees for the purpose of 
giving nursing care, determining whether or 
not the employee is receiving adequate care, 
or for other related reasons 

h. Interpretative services in behalf of an 
individual employee which shall include 
conferences with physicians, management. 


V 


and supervisory personnel for the purpose 
of interpreting an employee's physical and 
emotional capacity as it relates to his 
productivity as a worker, or to interpret 
real or suspected effects of the work 
environment on the health status of the 
employee 

i. Recording (professional notes) on employee's 
individual record 

j. Review of records for follow-up purposes 

2. Indirect services shall include those activities 
which are performed in behalf of the employee 
in areas which affect his health; these may be 
listed as follows: 

a. Educational activities, which shall include 
such activities as group teaching, pre¬ 
paration of articles for the plant paper, 
review and selection of pertinent health 
education materials, and the training (and 
supervision) of first aid workers 

b. Environmental sanitation and safety, which 
shall include such activities as attendance 
at safety committee meetings, participation 
in the investigation of accidents, plant 
inspection, reporting of suspected environ¬ 
mental hazards, and other related activities 

c. Reports, which shall include such activities 
as preparing compensation or accident 
reports, and collecting and tabulating data 
for preparation of monthly and special 
reports 


VI 


d. Administration of the health service, which 
shall include such activities as conferences 
with the physician or management for the 
purpose of discussing questions of operational 
policy and the preparation of manuals 

e. Maintenance of the health unit, which shall 
include such activities as cleaning and 
sterilizing instruments, setting up treat¬ 
ment tables and examining rooms, and other 
related activities 

f. Housekeeping, which shall include a 
multiplicity of activities which frequently 
the nurse must perform, such as putting 
away supplies, making beds, cleaning 
cabinets and equipment, dusting, and re¬ 
lated activities 

g. Clerical work, which shall include such 
activities as answering the telephone, 
filing, typing, and other general clerical 
work 

h. Recreational program, which shall include 
such activities as the nurse may perform 
in relation to the plant program 

3. Other activities shall include additional responsi¬ 
bilities which have been assigned to the nurse and 
which may or may not have a direct relationship 
to the plant health program. Also included in this 
broad category are professional activities and 
non-nursing activities which include non-health 
service clerical work, and personal and unoccupied 
time. 


Vll 


CONTENTS 


Foreword.iii 

Acknowledgments.iv 

Definitions. v 

EVENTS LEADING TO STUDY. 1 

NATURE AND SCOPE OF STUDY. 2 

Objectives. 2 

Scope of Study. 2 

Method. 2 

DESCRIPTIVE FACTS ABOUT THE SAMPLE. . . 5 

FACTORS INFLUENCING FUNCTION OF NURSE. . 8 

Plant policies.8 

Professional policies and practices.10 

Job responsibilities of nurses.13 

ACTIVITIES PERFORMED BY NURSES AND 
CLOCKED DURING WEEK OF OBSERVATION. . 18 

Direct services. 19 

Indirect services. 25 

Other activities. 27 

Summary of expenditure of nurses' time. 30 

DISCUSSION AND CONCLUSIONS.32 

RECOMMENDATIONS. 35 


• • • 
Vlll 


















EVENTS LEADING TO STUDY 


Early in the national emergency, the National Security 
Resources Board, realizing the shortage of nurses, asked 
the American Nurses' Association to estimate the number 
of nurses needed in the various fields of nursing. This 
request was referred by the American Nurses' Association 
to the joint board of the six national nursing organizations. 
At a meeting called to discuss this question, the president 
of the American Association of Industrial Nurses expressed 
the hope that some objective studies could be made for 
establishing valid ratios for estimating the number of nurses 
needed in the industrial health field. 

At about the same time, the Division of Nursing Re¬ 
sources, Public Health Service, had been assisting the 
states in making studies of all nursing service needs. In 
an attempt to gauge industrial nursing needs, the ratio of 
9 hours of nursing time per 100 employees per week was 
applied to the total working population. The resulting 
estimates, however, were so high in comparison with the 
number of nurses now believed to be employed in industry, 
that it was questionable whether that number of nurses was 
needed, or would find employment, in the field. 

To meet in part the obvious need for more information 
on nursing activities in industry, the Division of Occu¬ 
pational Health and Public Health Nursing agreed jointly 
to initiate a study. Because of limited funds and time, 
it was decided to confine this study of nursing services 
to a sample of small manufacturing plants. Small plants 
were considered to be especially appropriate for such a 
study, since they employ over 70 percent of American 
workers. The majority of these plants have limited, on 
location, medical consultation, and the major part of the 
responsibility for the administration and the direction of 
the health program is vested in the plant nurse. 


- 1 - 


NATURE AND SCOPE OF STUDY 


OBJECTIVES 

The objectives of the study were: 

1. To determine the scope of nursing activities in a sample 

of plants. 

2. To apply a time study method for the determination of 

the amount of nursing time spent on nursing functions 
and related activities. 

3. To secure additional information useful in formulating 

a methodology for determining the number of nurses 
required to meet employee health service needs. 


SCOPE OF STUDY 

The study was limited to twelve manufacturing plants 
in Georgia and Connecticut, ranging in size from 76 to 
1,479 employees. Each of eleven plants employed one 
full-time nurse, and the other plant employed two full¬ 
time nurses. It is not intended to imply either that the 
nursing services studied are representative of other health 
services existing in these states or in other industries 
throughout the country, or that they represent the optimum 
in occupational health programs. No attempt was made to’ 
evaluate the quality of nursing services. Insofar as possible, 
information pertaining to the policies and practices cur¬ 
rently in use in the health services studied were noted. 


METHOD 

The industrial hygiene bureaus of the State health 
departments were requested to select in their respective 
states good plant health services in moderately hazardous 
manufacturing industries. 


- 2 - 


Every effort was made to select plants of comparable 
size; but because of the difficulty encountered in finding 
plants having on-location medical consultation, the sample 
includes industries of fairly diversified size. 

In preparation for conducting the study, an advisory 
committee was appointed to consult with the Division and 
to assist in defining the scope, content, and techniques for 
making the study. 

Preliminary observations were made in industry for 
the purpose of clocking a random sampling of nursing 
activities and to select those which would lend themselves 
to timing. The publications Duties and Responsibilities 
of the Nurse in Industryl/and Nursing Practices in 
Industry2/were also used as a basis for selecting items 
to be included in the questionnaire and for clocking. 

Work sheets, including questionnaires, were designed 
to secure identifying data on the plant and information on 
the scope of the health program, as well as the professional 
policies under which the plant health service operates; and 
to record nursing activities observed and the amount of 
time spent on each activity. 

Before the study was started in the selected states, 
a trial run was made in a plant to test the usability of the 
work sheets, questionnaires, and the techniques for making 
the study. 


1/Committee on Professional Standards, AAIN: Duties 
and Responsibilities of the Nurse in Industry. American 
Association of Industrial Nurses, Inc., New York, N. Y., 1949, 

2/Whitlock, Olive M., et al.: Nursing Practices in 
Industry. Public Health Bulletin No. 283. U. S. Government 
Printing Office, Washington, D. C., 1944. 


- 3 - 








During the study, seven working days were spent at 
each plant. The first day was spent in meeting and be¬ 
coming acquainted with plant personnel concerned with 
the health program and in explaining the objectives and 
the purpose of the study. The nurses were requested to 
follow their usual routine and disregard, insofar as possi¬ 
ble, the observer. The following five days were devoted 
to keeping a record of the actual time, in minutes, spent 
by the nurse on each separate activity which she per¬ 
formed. Activities which required less than one minute 
were not included, and the time was charged to the ac¬ 
tivity just completed or the activity which followed. This 
did not exclude a single visit made by an employee to the 
health service facilities. The last day was spent in filling 
in the previously prepared questionnaire and in preparing 
a job description which included those activities for which 
the nurse was responsible. 

It is obvious that a week is too short a period to 
observe every activity for which the nurse may be re¬ 
sponsible. In an effort to obtain additional data, the nurses 
were asked to keep a record of the time spent on each ac¬ 
tivity for one month and to estimate the hours spent on 
broad areas of function. It was found that neither of these 
requests could be fulfilled because of the heavy work load 
in some plants and the time required for recording the 
information on the work sheets; nor were the nurses able 
to estimate, with any degree of accuracy, the number of 
hours spent on broad areas of function. 


- 4 - 


DESCRIPTIVE FACTS ABOUT THE SAMPLE 


The plants studied manufactured such article as food, 
food containers, textiles, chemicals, clothing, cosmetics, 
metal novelties, and railroad equipment and testing 
instruments. 

Table 1 shows by plant the numbers of employees and 
health service personnel. It will be noted that approximate¬ 
ly 1,000 dependents of the workers in plant 3 also used the 
health service facilities. Clerical service was available 
to the nurse and physician in two plants. All plant health 
facilities had maid or porter service for general cleaning, 
and five plants had additional part-time maid services to 
help with other housekeeping duties, such as cleaning 
equipment and cupboards, making beds, and similar routine 
duties. 

With one exception, a physician was employed by the 
industry to visit the plant and to give consultation on medical 
questions and problems. In one of the plants a physician 
was on call for emergencies and was available to consult 
with the nurse on specific medical questions which arose. 

The administrative responsibility for nursing activi¬ 
ties in the plants studied was vested most frequently in the 
personnel director, with the president or other executive 
and the plant manager ranking second. In one plant the 
nurse was responsible to the vice president through the 
personnel director, and in the three other plants the 
administrative responsibility was vested respectively in 
the full-time plant physician, the industrial relations 
manager, and the production manager. 

Table Z shows the education and work experience of 
the thirteen nurses employed full-time in the twelve plants 
included in the study. Seven of the nurses had some college 
\york. Of these seven, one had a degree in nursing education. 
Two others had three years of college study, one having 


- 5 - 


Table 1. — Kuaiber of employees, aod number of health service personnel^ by plant; observations from cursing stu^ 
of 12 plants with fever than 1,500 eaf>loy«es, 1951 


o 


tt 

O 

o 

#H 

r 

VI 

o 

1 

iSf 

H H 


O rH O H o o 

fo 

a 

0\ 'O CM 

0\ f-CM 

iH o O CM O O 

s 

O 

CN <30 

Number of health service personnel 

O rH O rH rH rH 


Ov 

CO r- fH 

C^ CO o\ 

NO H-sr 

O rH O H rH H 

Group 

B 

CO 


OrH O H 1 rH 

t*- 

^ la 

OHO H O O 

o 


OHO H O H 

\A 

SR 

CM r-l 

OHO H O O 


O \AU\ 

M CM On 

CM 

OHO H|0 


300* 

180 

120 

O O H H 1 H 

CM 

UN 0\A 
!>- r- O 

CM CM 


OHO H O O 


H 

)£ sa 

OHO H O O 

■ 

3l 

0 

• 


K as 

U\ <nCM 

vO <•> 


H O H w 

H H 

• 

f 


All eaplojees .. 

Males . 

Females . 

Fhyaiolanat 

PuU'tiae . 

Part-tiam. 

On-call . 

Nurses . 

Clerks . 

Maids, pairt-tims***.... 


- 6 - 


* Plus approximately 1,000 dependents. 

«* As needed and vibmn available. 

«** All health facilities had maid or porter service for general cleaning 





















































Table 2. — Replies to questions concerning education and eaqperience of 13 nurses; observations from nursing stu^y 
of 12 plants with fewer than 1,500 eaployees, 1^51 


o o o o 

ac K as e 

Yes 

No 

No 

No 

o O H o 

SB as as 

O ^ H O 

* ^ * 
lA 

No 

3 yrs 

No 

1 

O o O H 

z as z 

§ 

ZCNJ S H 

OOP o 

Z Z Z Z 

No 

15 cr 

1 

No 

No 

10 cr 

No 

No 

OOP P 

z z z z 

o o o o 

z z z z 

POO P 

z z z z 


m 

o 

« 

.. --a 

& 

s, 

rf 

a 


fH 

S 

o 

s 

2 

iH 





iH 


IZ 

£ 

£ 

£ 

M 

'S* 

« 

Sop 

SB 

Oi 

S 

o 

O 

& 




<A 

fa 


n 

<-ev 

fA 




£ 

cn 

o o o 
z z z 


IZ 

£ 

« 

CA 

« « 

Z O CM 

CM 

S 

« 

k 

*A 

s 

& 

CO 

k 


O 

z 


s 

S 

« 

\A 

<0 

Pv 


£ 

£ 

s 

O 

to 

fH 



to 

s 

NO 


a 

oo 

CM UNCO 


s 

£ 


n 

0\ 

s u 

z 

CM CA 

o 

z 

s 

£ 

£ 

1 

0\ 

h S 

o 

z 



£ 

c 

«0 







s 

s 

£ 






o\ 




lA 




CNJ 


w 

% 


§45 

-ri h 

to 

Q 


I 

O 

t 

I 

-P 

s 


« tt *0 

0) o 


M 4) 4) 

H • o 

iH Q U O 

o 

o_ 


V 

I 

I 

>p 

I 

gi 




t 

I 

_tL 


a -o TO 


o « 

S’ai't! 

Jd_ 


bD 

a 


jc: 

iH 

CO 

0> 

X 

u 

id 


o 


«M 

o 

n 

9 


I 


& 

§ 

1 


- 7 - 
























































majored in nursing education and one in public health nursing. 
Another one had 15 college credits and a course in industrial 
nursing. One had a 1-credit course in industrial nursing, at 
the university, and two others had taken basic courses at the 
university. Three of the thirteen had clinical post-graduate 
nursing courses, one in anesthesia, one in poliomyelitis, and 
one in pediatrics. Five of the thirteen had no formal education 
experience following their nurse's training course. 

The work experience of the nurses is indicated in table 2. 

Eleven of the thirteen nurses were members of the 
American Association of Industrial Nurses, and ten were 
members of the American Nurses' Association, 


FACTORS INFLUENCING FUNCTION OF NURSJ 

PLANT POLICIES 

There was minor variation from plant to plant in the scope 
of the occupational health programs, as shown in table 3. 

Preplacement health examinations were given to all 
employees in the twelve plants. Eight plants provided periodic 
health examinations to all employees, and two reported that 
these examinations are given only to factory workers, but that 
other employees may have them if they wish. Five plants re¬ 
ported that other health examinations, such as transfer and 
terminal examinations, are given on a selective basis. With 
one exception, the health examinations were given usually in 
the plant health service facilities. In one plant all employees 
were sent to the physician's office for health examinations. 

In several other plants employees were sent to the plant phy¬ 
sician's office on the days when he did not visit the plant. 

Eight plants reported some activity in the area of 
recreational programs. One of these was sponsored through 
community resources, and another one was relatively limited. 


- 8 - 





Table 3* — Replies to questions concerning plant policies 
affecting health service work-load; observations fTon 
nursing study of 12 plants with fewer than 1>500 eoployees, 
1951* (Billies received fron all 12 plants.) 


Question 

Number of 
plants replying 
in affirmative 

Are preplacenent health escaminations 


given to all eaqployees? . 

12 

Are periodic health evaal nations given 
toi 

All eiif>loyees? . 

8 

Factory workers only?. 

2 

Is there a recreation prograa for 

6 

eaployee group? . 

Are oE^lpyees required to report to the 
health service before reporting off duty 
on account of illxiess and injury?. 

10 

Are enployees req[uired to r^ort to the 
health service before returning to work 
following an illness or injxiry?. 

12 

Are hone visits made to eisployees?. 

8 

Is there a program for health and 

12 

safety education? .. 

Does the plant participate in coeiminity 

U 

mass-survey activities? ... 


- 9 - 















Ten plants requested employees to visit the health 
service before reporting off duty because of illness or 
injury, and employees in the other two plants were en¬ 
couraged to do so. 

All twelve plants requested employees to report to 
the health service following absence because of illness or 
injury. In this connection, the length of absence varied 
from one day in some plants to one month in another. 

Home visits were made by nurses in eight plants. 

In five of these plants the visits were infrequent and on 
a selective basis. 

All twelve plants reported some activity in health 
and safety education. 

Eleven of the plants participated in community chest 
X-ray surveys. The twelfth plant, which did not participate, 
took chest X-rays on all employees at the time of employ¬ 
ment and when periodic health examinations were given. 

In addition to the chest X-ray survey, the plants in one 
state participated in the syphilis survey. 


PROFESSIONAL POLICIES AND PRACTICES 

Established professional policies and practices were 
relatively uniform, as shown in table 4, 

None of the health service facilities had a completed 
nursing procedure manual, but in two plants the nurses 
were preparing such a manual which will include the 
functions of the nurse, emergency orders for the care of 
employees, procedures for selected nursing treatments, 
and other pertinent materials. Several plants had a 
manual which contained the policies of the company as 
they related to the health program, and they had inserted 
in this manual the plant physician's approved orders for 
emergency treatment. 


- 10 - 


Table li, — Replies to questions concerning professional practices; 
observations from nursing study of 12 plants vith fever than 
1,500 eaployees, 1951* (Replies received frm all 12 plants.) 


Question 

Number of 
plants relying 
in affirmative 

Is there a nursing procedxire manual? . 

2 

Are there physician-approved written orders 


for emergency treatment of employees? . 

6 

Are redressings or other follow-i^) treatment 
given to employees with coBq>ensable disabili¬ 
ties? ........................................ 

12 

If yes, are the physician's orders for 
treatment secured in 

a. Writing? . 

11 

b. Orally? . 

1 

Are treatments req[uested by private physicians 
for other than coapensation cases given in the 
health unit? . 

12 

If yes, are the physician's orders for 
treatment secured in 

a. Wilting?... 

11 

b. Orally?.... 

1 

Is a trained first aid worker responsible for 
emergency care when the nurse is absent from 

ihA unit?_ ................................ 

6 

Are individual cumulative health records kept 

for each employee? . 

7* 

Are health records kept confidential? . 

12 

Does the nurse submit repoi^s to management? . 

12 

Is nursing consultation available to the 

12 




* The 3 plants which kept only compensation and health examination 
reports in an individual folder are not included* 


11 

















Eight of the plants had physician-approved written 
orders for emergency care of sick or injured employees. 
Five of the written orders had not been reviewed since . 
early 1950, and one, which was dated prior to 1950, had 
not been reviewed by the present plant physician. 

All twelve plants reported that redressings and 
follow-up treatments are given in the health unit to 
employees who have compensable injuries or illnesses. 

The amount of care given varies, depending upon the 
physical facilities and the wishes of the physician who is 
caring for the patient. Eleven of the nurses reported that 
they obtained written orders for treatment from employees* 
private physicians, but that they accepted verbal orders 
for treatment from the plant physician. One secured 
written orders from both the plant and private physicians, 
and one accepted verbal orders for all treatments. 

All twelve plants reported that selected treatments 
and medications are given to employees when requested 
by their private physician for conditions other than com¬ 
pensable injuries and illnesses. Eleven of the nurses re¬ 
ported that they obtained written orders from the physician 
for all medications, and one accepted both written and 
verbal orders. 

In eight plants a first-aid worker was responsible 
for emergency care when the nurse was temporarily absent 
from the health unit. With one exception, all of these first- 
aid workers had been provided with written instructions. 

In three other plants employees gave themselves first aid 
from a kit, and in one an office employee gave first aid to 
employees during the absence of the nurse. Three nurses 
had a plan for the follow-up of all employees who had re¬ 
ceived first aid during their absence, and the others per¬ 
formed a follow-up only on the employees who required 
additional treatments or redressings. 


- 12 - 



In seven plants cumulative health records, which 
incorporated all available information on the health of 
an individual worker, were kept for each employee. In 
three others health examination reports and records of 
a compensable nature were filed in individual folders 
for each employee, but all recordings of visits were 
made in a log book. In one no provision had been made 
for filing any records in individual folders. 

All nurses reported that they submitted reports 

I to management on a weekly, monthly, or annual basis. 

These reports included a count of visits according to 
varied classifications. A few reported that a narrative 
was included, but those reviewed contained only a sentence 
or two which served to clarify a segment of the statistical 
report. 

i 

I Nursing consultation services from the State health 

I department were available to all nurses, and one nurse 
had access to nursing consultation from the plant's in- 
■ surance carrier. All of the nurses knew their consultant, 
but the majority seemed vague as to what kind of help 
; they might expect from her. 

I OB RESPONSIBILITIES OF NURSES 

There were minor variations in the broad areas of 
work in which the nurses functioned, but considerable 
variation in the degree of responsibility in these broad 
areas, as shown in table 5. 

Nursing Care for Injuries and Illnesses .--In the area 
of direct services to employees all nurses were responsible 
for emergency nursing care of industrial illnesses and in¬ 
juries, nonindustrial injuries, and medical complaints, and 
for interviews regarding health problems. 

Immunizations.--Six nurses carried some responsibility 
in an immunization program. Two gave influenza vaccine 
annually to all employees upon request. One gave typhoid 


- 13 - 





Table 5. — Replies to questions concernizig Job responsibilities of nursiqg 
personnel; (^serrations frota nursixig study of 12 plants with fewer than 1,500 
eiqployees, 1951* (Replies received ftrcai all 12 plants.) 


Question 

Number of 
plants replying 
in affirmative 

Direct services 


Care industrial illnesses and injuries . 

12 

Care non-industrial injuries . 

12 

Care medical ccnqplaints .. 

12 

Interviews regarding health problems .. 

12 

Tnmninlaatlons ..... 

6 

Health examinations ... 

12 

Procure history, Bwastire height and weight. 

10 

Vision testing.... 

7 

UftarlTUT ♦.eattnv .... 

0 

Temperature, pulse, respiration . 

6 

Rlocd pressure ............................................ 

3 

Collect laboratory specimens .. 

9 

Taboratfiry tests .........___......_....___... 

9 

Uidnalysls ..... 

8 

Rlocd work ..... 


T«rigrs, chest ..................................._ 

1 



Basal metabolism..... 

1 

Electrocardiogram . 

1 

Chaperone women workers . 

6 

Conferences with enployees regarding findings . 

11 

Recording physician's findings..... 

1 

UnmiA Trisit,a .. 

6 

12 

Interpretative services to management and supervisors ....... 

Recording of professional notes..... 

12 

Review of records for follow-up purposes. 

9 

Indirect services 


Environmental sanitation and safety . 

12 

plant inspections ... 

8 

Investigations of accidents . 

U 

Member of safety conmittee .. 

9 

Reports . 

12 

Monthly or annual . 

12 

Special reports... 

10 

9 

Condensation reports ... 

Admiidstration of the health service .. 

12 

Procure physician's written orders for oaergency treatment. 

12 

Conferences with manag«nenb and plaxit physician on policy.. 

12 

Planning space and equipment needs .. 

12 

Bdueation^ activities... 

11 

qrmip teaching .... 

]. 

Preparation of articles for plant paper . 

2 

Review and selection of health education materials . 

10 

Training and 8\q>ervislon of first-aid workers . 

7 

Recreation program (member of conmittee) . 

1 

Hooseke^ing and maintenance of the health service facilities 

12 

Clerical (health service) .... 

10 

Other activities 


Clerical (non-health service) .... 

3 

Care for dependents of endloyees . 

1 


14 - 



























































vaccines; another gave typhoid, diphtheria, and tetanus 
vaccines and vaccinations; and two gave immunizations 
of various types at infrequent intervals. 

Health Examinations .--The nurses in all twelve 
plants participated in the health examination program. 

The specific functions for which they were responsible 
varied widely. Ten secured all or a portion of the 
employee*s personal and medical history. In two plants 
the physician obtained the historyo Vision tests were 
performed by seven nurses, three of whom used an 
approved vision-testing machine. Hearing tests, when 
performed, were done exclusively by the physician. 

Eight nurses took temperature, pulse, and respiration. 

Ten measured height and weight. Only three took blood 
pressure readings. 

Nine nurses were responsible for collecting some 
laboratory specimens. Two collected only urine specimens, 
four collected urine specimens and drew blood for Kahn 
tests; three collected urine specimens and blood specimens 
for determining red and white cell counts and hemoglobin. 

Nine nurses were responsible for some laboratory 
tests. Simple routine urinalyses were performed by eight 
nurses, three of whom did microscopic tests when indi¬ 
cated. Five did some blood work. One did red and white 
counts on a selective basis and as ordered by the plant 
physician, and two determined hemoglobin only. Red and 
white cell counts and hemoglobin were done by two nurses, 
one of whom had been a laboratory technician prior to 
becoming a nurse. Only one nurse was responsible for 
taking X-rays and performing basal metabolism and 
electrocardiogram tests. 

Eight of the nurses chaperoned women workers dur¬ 
ing the health examinations. Eleven nurses shared re¬ 
sponsibility with the physician for interpreting to employees 
the physical findings. One acted as secretary to the physician 
and recorded his findings. 


- 15 - 



Home Visits«--Home visits were a responsibility of 
eight nurses, five of whom made home visits infrequently 
and on a selective basis. Two visited all ill employees, 
and one of these nurses was responsible for taking appli¬ 
cation blanks to employees entitled to make a claim for 
benefits under the sick benefit plan. 

Interpretative Services.--All nurses were responsible 
for some interpretative services on the health status of 
employees to management, the plant physician, private 
physicians, and other community health and social facilities. 

Recording.--All nurses were responsible for keeping 
a record of services rendered. 

Review of Records for Follow-up,—Nine nurses con¬ 
sidered themselves responsible for reviewing their records 
for follow-up purposes. 

Sanitation and Safety,--In the area of indirect services 
all nurses were responsible for some phase of the sanitation 
and safety program. One was responsible for the entire 
sanitation and ssifety program in the plant. Two participated 
only to the extent of sharing any observations or information 
bearing on the plant safety and sanitation program. Plant 
tours were made by eight nurses. Of these, one was re¬ 
sponsible for the supervision of the sanitation of the washrooms 
and toilets, and another was responsible for the sanitation 
of the cafeteria, washrooms, dressing rooms, and toilets. 

Four participated in the investigation of accidents. Nine were 
members of the safety committee, two of these nurses serving 
as secretaries of the committee. 

Reports,--All nurses were responsible for preparing 
reports for management on the activities of the health service 
program. Nine were responsible for compensation, and three, 
for reports on absenteeism. 


- 16 - 








Administration of Health Service,--Eleven nurses 
were responsible for the management of the health service 
facilities, and one carried a portion of the responsibility 
when the full-time physician was not on duty. All considered 
it their duty to secure physician-approved written orders for 
emergency care of sick and injured employees, but four had 
not yet obtained them. None of the nurses was totally re¬ 
sponsible for planning space and equipment needs, but all 
participated in this activity. 

Educational Activities. --Eleven nurses were responsible 
for some phase of an educational program. Ten reviewed and 
selected health education materials. Seven trained and super¬ 
vised the first-aid workers. Two prepared articles for the 
plant paper, and four were responsible for group teaching. 

One held classes twice a year on personal hygiene; another 
participated in the in-service training program for super¬ 
visors on sanitation and safety; another taught first aid to 
supervisors and key personnel; and the fourth held classes 
on pertinent subjects as the need indicated. Three were co¬ 
operating with local universities in providing observations 
and field experience for nurses who are preparing them¬ 
selves to work in this field. 

Housekeeping and Maintenance of the Health Service 
Facilities.--All nurses were ultimately responsible for the 
maintenance and housekeeping of the health service facilities, 
but two had sufficient maid service so that their primary 
function in this area was the supervision of the maid. 

Clerical Work.--All except two nurses were responsible 
for the major part of the clerical work originating in the 
health service. Two had half-time clerical workers, with 
access to their services at other times during the day. Three 
others had some work done in the main office whenever the 
clerks were available. 

Recreation Programs.--One nurse was a member of 
the employee recreation committee. 


- 17 - 








Miscellaneous Activities.--One nurse was responsible 
for emergency care for dependents of the employee group, 
for conducting a child health clinic, and for the administration 
and supervision of a nursery for pre-school children. 

Two nurses were responsible for non-health service 
general clerical work in the plant; one, for two hours of 
clerical work per day; and the other one, for general 
clerical work when time was available. A third was oc¬ 
casionally given clerical work to perform when the office 
clerks in the plant were overburdened. 

Two other nurses were responsible for ordering flowers 
for employees who were off ill. 

Outside Activities,—In addition to responsibilities 
connected with the health program, five nurses held offices 
in their local industrial nurses' association. Two were 
presidents of the local club, one of them also serving as 
vice president of the State Industrial Nurses' Association. 

One was a member of the board of directors of the State 
Industrial Nurses' Association; another was secretary for 
the local club; and another was chairman of one of the work¬ 
ing committees of the local club. 


ACTIVITIES PERFORMED BY NURSES AND 
CLOCKED DURING WEEK OF OBSERVATION 


With one exception, the regular work week for nurses in 
the twelve plants studied was 40 hours. One nurse worked 
36 1/2 hours per week. Because all of the nurses, except two, 
considered themselves on call for emergencies during the 
lunch period, the percentage distribution of time has been 
calculated on the basis of the number of hours spent from 
the time that the nurse entered the plant in the morning until 
she left it at night. 


- 18 - 




- Tables 6 and 7 reflect the experience of nurses 
in plants grouped according to the size of the employee 
population: those under 250, 250 to 499, 500 to 999, 
and 1,000 to 1,499; hereafter, these four groups will 
be referred to as groups A, B, C, and D, respectively. 
Eleven plants were served by one nurse each; the 
twelfth plant had two nurses. This plant falls in group C. 

Since the analyses showed no marked sex differences 
with reference to the utilization of the health services 
the data for males and females have been combined in 
the material that follows. 

It is quite probable that there would have been a 
different percentage distribution of time among the 
specific activities if observations had been made at 
another period, for example one month earlier or 
later. 

Table 6 shows the percentage distribution of 
nursing time according to specified activity, while 
table 7 shows the number of direct services per 
100 employees, according to specified activity. In 
this connection the number of direct services refers 
to the number of employee visits. 


DIRECT SERVICES 

It will be noted in table 6 that the percentage dis¬ 
tribution of nurses' time spent on direct services varied 
from 23 percent in group A, to 54 percent in group D, 
Table 7 shows that the volume of work varied from 17 
services per 100 employees in group D to 82 services 


- 19 - 


Table 6. — Percentage dletribiitlcm of noreijog tiiae, according to ^eelfled actlrity during 
a week of obserratlon; mrslng study of 12 plants vlth fewer than 1,500 o^loyees, 1951 


letiTlties 

Sise of plant (nniber of eagilpyees) 

All j 

&aup 

plants 

A 

L B 


D 

Percent of nursing tlas 

All activities . 

100.0 

100.0 

100.0 

100.0 

100.0 


a 

Lrect sen 

rices for 

esployeei 


Total direct services .................. 

wrr 

2S.5 

la.7 

i|6.8 


Care for industrial injuries and illnesses... 

6.1 

2.3 

7.5 

5.2 

3.8 

Care for nonindustrial injuries. 

1.9 

.3 

2.ii 

1.8 

.7 

Care for nedical complaints .... 

13.3 

7.7 

10.2 • 

19.0 

17.8 

Interviews regarding health probloa ... 

2Jt 

l.ii 

3.1 

1.3 

2.Ji 

Iwnnlsations. 

« 

- 

« 

- 

- 

Health evani nirtione.... 

6.5 

2.9 

2.8 

12 Ui 

11.6 

Hoae vlaits ... 

l.ll 

- 

2.6 

- 

- 

Interpretative services in behalf of 






individual ei^loyees.... 

U.o 

1.1 

5.3 

2.1i 

3.8 

Recording...... 

6.5 

6.5 

6.7 

it.6 

13.3 

Review of records for follow-i^> purposes .... 

.2 

.3 

.3 

.1 

• 

Others... 

.It 

- 

.8 

« 

- 


Indirect services for e^tloyees 

Total indirect sa"vice3.. 

28.9 

38.7 

26.0 

33.0 

22.6 

Bducatlonal activities.... 

.7 

5.0 

.3 

.3 

• 

Snvironental sanitatiMi and safety.. 

1.9 

it.6 

2U 

.5 

2.1 

Rm>orts.... 

1.7 

7.1 

1.3 

.8 

2.2 

Adninistratlon of health service... 

2.6 

2.9 

3.0 

1.0 

5Ji 

Naintenance of the health unit .............. 

ii.l 

2.7 

3.6 

5.8 

2.2 

HousekemdJig activities ... 

U.5 

li.9 

lt.O 

6.2 

.6 

Clerlcalt telephoning, typing, filing, others 

13.2 

11.5 

11.1 

18.1 

10.1 

Recreation program, others.. 

.2 

- 

.3 

.3 

- 


Otbar activities 

Total other activitlea ... 

28:5^ 

38.8 

32.3 

20.2 

23.8 

Care of dependents and supervision of lairsexy 

1.3 

- 

2Ui 

- 

- 

Uslaon activities with coBanuiity agencies .. 

.1 

- 

.3 

- 

- 

Professional arganlxation activities .. 

.3 

.2 

.5 

• 

• 

Rcfaesional reading ..... 

.9 

- 

.3 

2.5 

• 

Ion-nursing activities.. 

13.5 

27.1 

Ut.a 

6,h 

UU 

Lunch period ....... 

8.9 

7.2 

9.8 

8.0 

7.0 

Rest period ... 

3.k 

U.3 

lt.2 

1.3 

5.1 

Muaber of nmhMi^777?^rZT.vr:.. 

.. ..13 

1 

7 

-5“ 

1 

Honber of hours on duty ..... 

562 

li2.5 

302.5 

173.7 

lt3.7 

■ndier of plants.... 

12 

1 

7 

3 

1 

Average laaber of eigiloyeea.. 

6,597 

76 

2,l6itMi 

2,578 

l,it79 

Ilalea ... 

3,319 

63 

1,267 

1,807 

182 

. 

3,278 

13 

1,197 

771 

1,297 


* Less than .05 of 1 percent. 

** In addltiaii to aq>loyee8 ippraxiJHtely 1,000 dQ>endents. 

■ota It Da sh (•) Indicates aetiTity was ncA perforsed by nnrse during week obserred. 
lote 2t The 12 plants classilled sisa into li groups (under 250 enployees, 25tV-lt99, 500* 
959, and l,00(^l,li99) are referred to in the text as gro up s A, B, C and D, respee- 
tiwaly. 


-20 - 



































































Table 1. — Nuaber of direct services per 100 eaployees according to 
specified service during a week of observation; nursing stuity of 12 
plants with fewer than 1,500 en)loyees, 1951 



Sise of plant (number of eiployees) 

Services 

AU 


Qrouqp 



plants 

A 

B 

c 

D 


Nuiid>er of servi 

Lces per 100 eiployees 

Total direct services . 

36.1 

81.6 

lt8.1 

3U.0 

17.U 

Care for industrial injuries and 






Illnesses .. 

6.0 

13.2 

10.6 

3.8 

1.8 

Care for nonindustrial injuries . 

2.0 

1.3 

3.5 

l.lt 

.It 

Care for aedical complaints . 

18.0 

36.8 

17.6 

22.3 

10.1 

Interviews regarding health problems.. 

1.8 

5.3 

3.3 

.8 

.8 

laauxLaations ... 

« 

- 

.1 

- 


Health examinations . 

1.8 

2.6 

1.5 

2.2 

l.lt 

Bom visits . 

.2 

- 

.6 

- 

- 

Interpretative services in behalf of 
individual employees... 

3.1 

7.9 

5.7 

1.3 

1.1» 

Recording . 

3.0 

13.2 

U.6 

2.0 

1.5 

Review of reooards for foUow-ip 
purposes . 

.1 

1.3 

.2 

.1 


Oth«*s. 

.1 

• 

.u 

.1 

•• 

Average number of employees . 

6,597 

76 

2,li6it 

2,^8 

l,lt79 


* Less than .05 of 1 percent. 

Note 1: Dash (—) indicates actlvitj was not perfomed by nurse during 


week observed. 

Note 2: The 12 plants classified by aiae into it groups (under 250 eaployees^ 
2$0-h99t 500-999, and 1,000-I,lt99) are referred to in the text as 
groups A, B, C and D, respectively. 


- 21 - 


























in group A. An average of 36 services per 100 employees 
was rendered by all nurses, and 43 percent of their time 
was spent on activities in this category. 

Industrial Injuries and Illnesses.--Time spent on 
the care of industrial injuries and illnesses varied from 
2 percent in group A to 8 percent in group B, The number 
of services rendered per 100 employees varied from 2 
in group D to 13 in group A. An average of 6 services 
per 100 employees was rendered by all nurses and ac¬ 
counted for 6 percent of their total time. 

Nonindustrial Injuries.^-Time spent on the care of 
nonindustrial injuries varied from less than 1 percent 
in groups A and D to 2 percent in group B, The number 
of services rendered per 100 employees varied from 
less than 1 in group D to 4 in group B. An average of 
2 services per 100 employees was rendered by all nurses, 
and 2 percent of all nurses' time was spent on this activity. 

Medical Complaints,--Time spent on the care of 
medical complaints was higher than for any other direct 
service. The range varied from 8 percent in group A 
to 19 percent in group C, The number of services rendered 
per 100 employees varied from 10 in group D to 37 services 
in group A. An average of 18 services per 100 employees 
was rendered by all nurses, and 13 percent of all time was 
spent in this activity. 

Interviews Regarding Health Problems .--Time spent 
on this activity was observed in eleven plants and varied 
from 1 percent in groups A and C to 3 percent in group B, 
The number of services rendered per 100 employees varied 
from less than 1 in groups C and D to 5 in group A. An 
average of 2 services per 100 employees was rendered by 
all nurses and accounted for 2 percent of their time. The 
amount of time spent and the number of services rendered 


- 22 - 






do not reflect the total activity in this area because 
some health information was also given to employees 
visiting the health service for another reason. 

Immunizations,--Immunizations were given in one 
plant during the week of observation, and the time con¬ 
sumed was relatively negligible. 

Health Examinations.--Time spent on health exami¬ 
nations varied widely, from 3 percent in groups A and B 
to 12 percent in group C. The number of health exami¬ 
nations performed per 100 employees ranged from 1 in 
groups B and D, to 3 in group A, An average of 2 exami¬ 
nations per 100 employees was performed, and 7 percent 
of all nurses* time was spent on this activity. There were 
many reasons for this wide variation, particularly with 
reference to time. For one thing, various types of health 
examinations were given; these ranged from a relatively 
simple health examination to a rather complete one, in¬ 
cluding X-ray of the chest; the determination of red and 
white cell counts, and hemoglobin; and urinalysis. In one 
plant additional X-ray pictures and laboratory tests, such 
as basal metabolism rate, electrocardiogram tests, and 
others, were made when indicated. Another reason was 

the varying degree to which the plant physician delegated 
responsibility to the nurse. 

As was indicated previously, table 5 shows the extent 
to which the nurses participated in the performance of 
health examinations. However, this table does not indicate 
the completeness of the activity. For example, the nurses 
took histories in several plants; but the health histories 
taken in some plants were much more complete and de¬ 
tailed than the ones taken in the other plants. In like manner, 
vision testing was done by the nurses in 7 plants; but in 


- 23 - 




some plants a Snellen chart was used, while in others an 
approved vision testing machine was used, and the exami¬ 
nations were thus more time consuming. It will also be 
noted in table 5 that five nurses were responsible for 
laboratory blood tests, bul^ again, in some plants these 
tests were more extensive than in others. 

Home Visits.--Home visits were made by three nurses 
in group B during the week of observation. This activity 
accounted for 3 percent of their time, and the number of 
visits made was less than 1 per 100 employees. There 
was a wide variation in the amount of time spent by these 
three nurses. The primary reason for this variation was 
the travel time involved. In one plant all employees visited 
lived within a short distance of the plant. In another plant 
the employees lived scattered in a large metropolitan area, 
and slightly over 67 percent of the time spent on home visit¬ 
ing was actually travel time. 

Interpretative Services.--Time spent on providing 
interpretative services regarding the health status of 
individual employees to management, plant physician, 
private physicians, and others varied from 1 percent in 
group A, to 5 percent in group B. It accounted for 4 per¬ 
cent of all nursing time. 

In those plants where the greatest activity was 
observed in this area, the nurses seemed to have 
effective working relationships within the plant as well 
as with private physicians and other agencies within 
the community. For example, in two of the plants the 
personnel director, nurse, and plant physician worked 
closely on job placement and on the follow-up of 
employees who were off duty because of illness or injury. 

In like manner, there were frequent communications with 
the private physician who was treating the employee in 
his home or in a hospital. 


- 24 - 




Recording .--Re cor ding of professional notes on 
the employee's cumulative health record is generally 
considered to be a part of the service given to an 
employee. However, to save the employee's time when 
the health service is busy, many nurses use some type 
of log where they enter his name, together with notes 
on services provided. Later, as time permits, these 
notes are amplified and transferred to the employee's 
record. Therefore, the number of services in 
connection with recording in table 7 refers to intervals 
of recording rather than to the number of individual 
records written during the week of observation. The 
time spent on recording varied from 5 percent in group 
C to 13 percent in group D, The number of intervals 
per 100 employees devoted to recording varied from 
2 in groups C and D to 13 in group A, This activity 
accounted for 7 percent of all nurses' time. In group 
C one nurse dictated most of her notes to a part-time 
secretary, while the other nurses did their recording 
in long hand. There was considerable variation among 
plants due primarily to a variety of record systems, 
some of which were more complete than others. 


Review of Records for Follow-up Puposes .—Review 
of records for follow-up purposes was observed in seven 
plants in groups A, B, and C. The time spent on this 
activity was less than 1 percent in all groups. 


Other,--Other activities in the area of direct services 
were observed in three plants in groups B and C and con¬ 
sisted primarily of telephone calls to and from employees 
who were off duty ill; in one instance, a sick employee was 
accompanied to his home. 


- 25 - 





INDIRECT SERVICES 


It will be noted in table 6 that there was considerable 
variation from group to group in the amount of time spent 
on indirect services. This was probably due primarily to 
the size of the employee population, differences in the scope 
of health programs as they affected the function of the nurse, 
and the amount of clerical and housekeeping assistance which 
was provided to the health service. The time spent on in¬ 
direct services varied from 23 percent in group D, to 39 per¬ 
cent in group A. All nurses spent an average of 29 percent 
of their time providing indirect services. 

Education.—Educational activities directed toward the 
employee groups were observed in six plants during the week 
of observation. The time spent varied from less than 1 per¬ 
cent in groups B and C to 5 percent in group A. Activities 
observed consisted of reviewing health education materials, 
preparing articles for plant papers, and setting up exhibits. 

Environmental Sanitation and Safety.--Time spent on 
programs of environmental sanitation and safety ranged 
from less than 1 percent in group C, to 5 percent in group 
A. All nurses spent an average of 2 percent of their time 
in this activity. Activities observed consisted of plant 
tours, attendance at safety committee meetings, partici¬ 
pation in the investigation of accidents, and conferences 
with the safety director or supervisors regarding accidents 
or potential accident hazards. 

Reports.--In nine plants time was spent on reports to 
management during the week of observation. The amount of 
time spent varied from less than 1 percent in group C to 7 
percent in group A. Reports were prepared on monthly ac¬ 
tivity, compensation costs, and absenteeism. In addition, 
special reports were prepared, as requested by management. 


- 26 - 





Administration of Health Service .--All nurses spent 
time during the week of observation on the administration 
of the health service. The amount of time spent ranged 
from 1 percent in group C, where one plant employed a 
full-time medical director, to 5 percent in group D. 
Activities observed consisted of conferences with manage¬ 
ment and the plant physician regarding policy, planning 
for changes in physical facilities, preparation of written 
orders for emergency treatment of sick and injured 
employees, redesigning of record forms, and planning 
for new equipment. 


Maintenance of the Health Unit.--Time spent on the 
maintenance of the health unit varied from 2 percent in 
group D to 6 percent in group C. An average of 4 per¬ 
cent of the total time of all nurses was spent for this work. 
Activities observed consisted of cleaning and sterilizing 
instruments and equipment; setting up treatment table and 
examining rooms; refilling stock bottles; and checking, 
cleaning, and replenishing first-aid kits. 


Housekeeping.--Time spent on housekeeping activities 
ranged from less than 1 percent in group D to 6 percent in 
group C. This activity accounted, on the average, for 5 per¬ 
cent of the total time spent by all the nurses. Activities 
observed consisted of storing supplies; making beds; dusting, 
cleaning, and arranging cabinets; folding gauze bandages; 
and cleaning laboratory glassware and safety equipment. 

Activities having to do with the maintenance of the 
health unit and housekeeping have purposely been grouped 
separately because it was believed that there might be some 
difference of opinion as to whether or not some of the 
activities listed under the maintenance of the health unit 
require the professional skills of the nurse. It should be 


- 27 - 





stated at this time that hospitals and public health organ¬ 
izations have demonstrated that trained aides can perform 
most, if not all, of the activities grouped under the main¬ 
tenance of the health unit. 

Health Service Clerical Work.--Time spent on health 
service clerical work ranged from 10 percent in group D 
to 18 percent in group C, One of the plants in group C was 
staffed with two nurses, and it had an extremely busy health 
service and no clerical assistance. Activities observed in 
this area consisted of answering the telephone, filing, typing, 
making tabulations for statistical reports, preparing routine 
reports, and writing routine letters. 

Recreational Program and Other Activities. — One of 
the seven nurses in group B spent 2 percent of her time 
on the employee recreational program during the week of 
observation. Another nurse in group D spent time on 
miscellaneous welfare services. 


OTHER ACTIVITIES 

Other activities included a group of miscellaneous 
activities assigned to the nurse, lunch periods, rest periods, 
and non-nursing activities, which include non-health service 
clerical work, and personal and unoccupied time. Time 
spent on other activities ranged from 20 percent in group 
C to 39 percent in group A, See table 6, 

Care of Dependents.--One of the seven nurses in group 
B spent 18 percent of her time during the week of observation 
providing emergency care and preventive services for de¬ 
pendents of the employee group. Activities observed con¬ 
sisted of administering and supervising a "nursery for pre¬ 
school children," conducting a child health clinic for pre¬ 
school children, and providing emergency care for illnesses 
and injuries. A total of 38 different intervals of time was 
devoted to this activity. 


- 28 - 





Liaison Activities with Community Agencies .--One of 
the seven nurses in group B spent 2 percent of her time 
during the week of observation on liaison activities with 
community agencies, which included a conference with the 
local visiting nurse association regarding their respective 
programs and a similar conference with the department of 
health. 

Professional Organizational Activities.--The nurse in 
group A and two nurses in group B spent time carrying out 
officer responsibilities in connection with their professional 
nursing organizations. The time spent was less than 1 per¬ 
cent in both groups. Activities observed consisted of planning 
an agenda for a meeting, reviewing by-laws for the local in¬ 
dustrial nurses' club, handling telephone calls to and from 
club members regarding plans for the meeting, and similar 
activities. The plant managements seemed to accept the fact 
that their nurse had a responsibility in this area, and one 
personnel director told the observer that they were proud 
that their nurse held an office in her professional organization. 

Professional Reading,--During the week of observation 
two nurses in group B and one nurse in group C spent time on 
professional reading and in consulting technical references for 
information on medical and health problems which had been 
presented to them by employees. The time spent ranged from 
less than 1 percent in group B to 3 percent in group C. 

Non-Nursing Activities.--Time spent on non-nursing 
activities ranged from 8 percent in group C to 27 percent in 
group A. An average of 14 percent of all nursing time was 
spent in this area. Observations in this category included 
non-health service clerical work, making change for vending 
machines, ordering flowers for sick employees, personal and 
unoccupied time. 

Non-health service clerical work, typing and proofreading, 
was observed in three plants, and the time spent ranged from 1 
percent in two plants to 2 percent in another. The average for 
the three plants was 2 percent. 


- 29 - 






Time spent on personal items ranged from less 
than 1 percent in one plant to 10 percent in another. 

Four spent less than 2 percent of their time on personal 
items, while four others spent less than 5 percent. 

Unoccupied time was observed in eleven plants, and 
the time spent ranged from less than 1 percent in two 
plants to 31 percent in another. The larger percentages 
were observed in two plants. One plant had less than 15 
minutes; four had less than one-half hour, andyhnother 
four had between 1 and 3 hours of unoccupied time. 

The amount of unoccupied time observed may have 
been due to several reasons. Four nurses reported their 
units less busy than usual during the week of observation. 
Some nurses may have functioned differently with an 
observer present. In some instances, they may have 
lacked the ability and knowledge to utilize time when the 
flow of work dropped below the usual level. 

Scheduled lunch periods varied from 30 minutes to 
1 hour, depending upon the policy of the plant. All except 
two plants had a cafeteria or lunch bar, and the time spent 
for lunch usually was dependent on the time required to go 
through the cafeteria line, to be served, and to eat limch. 
The time spent on this activity varied from 7 percent in 
groups A and D to 10 percent in group B, where two 
nurses went home to lunch. The all-plant average was 
9 percent, or approximately 45 minutes. During the week 
of observation the nurse in plant 4 had two luncheon con¬ 
ferences with representatives from community agencies, 
and the time was charged to "liaison activities with com¬ 
munity agencies." 

In eleven plants all employees were allowed rest 
periods varying from 10 to 15 minutes, depending upon 
the policy of the plant. The time spent varied from 1 per¬ 
cent in group C to 5 percent in group D, The all-plant 
average was 3 percent. 


- 30 - 


SUMMARY OF EXPENDITURE OF NURSES' TIME 


Table 8 shows a summary of the expenditure of nurses' 
time during the week of observation. As anticipated, the 
amount of time spent on direct services to employees in¬ 
creased as the employee population increased. In contrast 
to this, the average time devoted to providing services to 
individual employees decreased as the employee population 
increased. 

Other data secured and tabulated, but not included in 
the tables, show that there was wide variation in the way 
in which nurses' time was utilized, even in plants of com¬ 
parable size. For example, in group B, which includes 
plants ranging in size from 250 to 499 employees, there 
was considerable variation in the demand for services from 
the employee groups. In one plant with an employee popu¬ 
lation of 300, a total of 46 services were rendered in 
connection with injuries, medical complaints, and health 
examinations; while in another plant with 363 employees a 
total of 190 services were rendered. The amount of time 
spent on providing these services ranged from 17 to 32 
percent. This same type of variation occurred in group C. 

In the area of indirect services there also was con¬ 
siderable variation from plant to plant in the way in which 
nurses* time was utilized. In six plants nurses spent time 
on educational activities, but the time varied from less than 
1 percent in four plants to 5 percent in another. Time was 
spent on sanitation and safety in all plants, but the amount 
varied from less than 1 percent in five plants to 8 percent 
in another. Without exception, the largest block of time 
spent in the area of indirect service was on housekeeping, 
maintenance of the health unit, and general health service 
clerical work. These activities accounted for 22 percent 
of all nursing time during the week of observation. 


- 31 - 


Table 8. — Sumaary of expenditure of nursing time, and activities 
perfcrmed, during a week of observation, by size of plant; nursing 
stucfy of 12 plants with fewer than 1,$00 enployees, 1951 


Activities 

All 

plants 

Size of plant (number of eaployees) 

Qroup 

A 

B 

C 

D 



Pei^jent 

of nursing tiats 


All activities . 

100.0 

100.0 

100.0 

100.0 

100.0 

Direct services . 

1*2.7 

22.5 

ia.7 

1*6.8 

53.6 

All other activities . 

57.3 

77.5 

58.3 

53.2 

1*6.1* 


Avera 

ge number 

of adnutes per activity 

All activities ......... 

8.6 

ll*.7 

8.9 

7.7 

7.1 

Direct services . 

6.1 

9.2 

6.1* 

5.6 

5.5 

All other activities ........ 

12.1* 

17.7 

12.1* 

11.7 

10.8 


Average number 

of activ! 

Lties per 

nurse 

All activities . 

302.5 

17l*.0 

291.0 

337.8 

370.0 

Direct services . 

183.0 

62,0 

169.1 

219.0 

257.0 

All other activities . 

119.5 

112.0 

121.9 

118.8 

113.0 


Total nuaiber of activii 

ties perforaed 

All activities . 

3,932 

171* 

2,037 

1,351 

370 

Direct services . 

2,379 

62 

1,181* 

876 

257 

All other activities .. 

1,553 

112 

853 

1*75 

113 


Total nunber of minutes 

nurses on duty 

All activities . 

33,71*5 

2,550 

18,11*9 

10,1*21 

2,625 

Direct services . 

11*,1*20 

573 

7,562 

1*,878 

1,1*07 

All other activities . 

19,325 

1,977 

10,587 

5,51*3 

1,218 

Nuaiber of nurses . 

13 

1 

7 

1* 

1 

Average nunber of eogplpyees.* 

6,597 

76 

2,1*61* 

2,578 

l,li79 


Note It "All other activities" Includes indirect services for enployees, 
and other activities* 

Rote 2t The 12 plants classified size into li groves (under 2$0 eog>loyee8, 
250-U99* 50(^999, and 1,000-1,1*99) are referred to in the text as 
grovg>s A, B, C and D, respectively. 


- 32 - 





























































In the area of other activities there was an even 
wider variation in the way in which time was utilized. 

In one plant the nurse spent 18 percent of her time on 
providing services to dependents. One spent two per¬ 
cent of her time in conferences with personnel from 
community agencies. Several nurses spent time on 
professional activities and reading. Nurses in three 
plants in group B and in one plant in group C were so 
busy with professional services to employees and the 
accompanying clerical and housekeeping activities 
that the time spent on other non-nursing activities was 
low as compared with that found in other plants. Non¬ 
nursing activities, exclusive of health service clerical 
work and housekeeping, accounted for 14 percent of all 
nursing time, and the variations among the twelve plants 
ranged from 2 to 41 percent. 

There seemed to be a tendency for the time spent on 
non-nursing activities to be greater in the smaller plants, 
where the demands for service to employees was less 
pressing. This may be due to the fact that these nurses 
and plant management need nursing consultative help to 
plan for better utilization of nursing time, or the smaller 
plants may not need the services of a full-time nurse. 


DISCUSSION AND CONCLUSIONS 

The data tabulated and discussed in this report re¬ 
present the experience of twelve manufacturing plants, 
ranging in size from 76 to 1,479 employees, during one 
week of observation. Eleven plants were staffed with one 
nurse each, and the twelfth plant employed two nurses. 

The activities performed by nurses and clocked during 
the week of observation have been grouped to conform with 
the recommendations set forth in the American Association 
of Industrial Nurses' publication. Duties and Responsibilities 
of the Nurse in Industry. 



- 33 - 




All of the nurses were found to be functioning in 
the broad areas of activities as outlined in this document, 
but some of the duties were not performed in all plants 
during the week of observation. There was considerable 
variation from plant to plant in the degree of responsibility 
assigned to the nurse, particularly in the areas of health 
examinations, and sanitation and safety. In four plants 
the nurses' responsibilities were limited by the adminis¬ 
trative plan of management. In one plant, the nurse had 
such a heavy program of providing health services to 
employees that she was prevented from fulfilling her 
assigned responsibilities in sanitation. Some nurses were 
observed to be carrying responsibilities not specifically 
mentioned in the Duties and Responsibilities of the Nurse 
in Industry. Several were making home visits, and others 
were participating in an immunization program. Another 
provided services to dependents of employees which in¬ 
cluded emergency care, holding a child health clinic for 
pre-school children, and administering and supervising 
a nursery for pre-school children. Another spent time 
with nursing students who were visiting the plant and the 
plant health service. 

The amount of time spent on direct and indirect 
services, exclusive of housekeeping and general health 
service clerical work, accounted for 42 to 63 percent 
of the nurses' time. There are no available valid standards 
against which to judge how the nurses' time should be 
allocated to the various program elements. However, in 
some instances, it would seem that time spent on non¬ 
nursing activities, such as clerical and housekeeping, 
and in unoccupied time could have been utilized to better 
advantage. For example, in several plants nursing time 
could have been used effectively on formulating a planned 
procedure for follow-up of those employees who have 
received emergency treatment from a first-aid worker; 
organizing and maintaining a record system which would 
incorporate into individual employee folders all infor¬ 
mation on services rendered; drafting copies of written 
orders for emergency care of employees for the physician's 



- 34 - 




approval and signature; or more time could have been spent 
preparing narrative reports to management. 

The professional practices which had been established 
in the plants studied were fairly uniform, but some were not 
in accordance with those recommended by the American 
Association of Industrial Nurses or with those found in the 
publication Nursing Practices in Industry. 

It is difficult to evaluate with any degree of accuracy 
the correlation, if any, between the education and experience 
of the nurse and the utilization of her time and the pro¬ 
fessional standards which were currently in effect in the 
health service programs. Even in this small sample of 
plants, there were many variables which could distort apparent 
correlation, such as the size of the employee population and 
the volume of the emergency work load, managements' 
philosophies as to the nurses' function, and the individual 
nurse's innate potentials for planning and organizing her work. 
Data from a larger sample are necessary before valid con¬ 
clusions can be drawn. 

There seemed to be no relationship between the salary 
paid to nurses and their educational background and length of 
service with the company. For example, in the two plants 
paying the lowest salaries, one nurse had been with the company 
one year, and the other one, fourteen years. The nurse 
receiving the highest salary had been with the company three 
years and had no educational experience since nurses' training. 

Time studies serve a useful purpose in that they are an 
excellent device for uncovering time being devoted to non¬ 
nursing activities, such as clerical and housekeeping duties 
and unoccupied time. This time can be utilized more effectively 
when the program objectives are directed toward such preventive 
measures as case-finding, follow-through, health counseling, and 
rehabilitation. 


- 35 - 



Because knowledge as to the extent of the actual 
need for health services is basic to the determination 
of the amount of nursing time required in industry, it 
is obvious that valid conclusions cannot be drawn from 
the use of the time study alone. Such studies reflect 
what is now being done in existing programs without 
considering whether or not these programs are meet¬ 
ing current employee health service needs. 


RECOMMENDATIONS 

To determine how much nursing service can 
profitably be used by industry, the employee health 
service needs should first be defined. This would 
mean establishing criteria for predetermining the 
health service needs of employee groups. Demon¬ 
strations of plant health programs which would pro¬ 
vide all types of occupational health services, in a 
situation where management and the nursing and 
medical professions are cooperating fully, would also 
contribute much practical information. 

1. Wherever possible, studies of health services 
should be approached on a team basis. This means 
that medical and nursing service should be studied 
together because a large portion of the nurse's area 
of function is dependent upon the experience and 
philosophy of the plant physician, and the policies and 
practices which he establishes. 

2. The plant physician, nurse, and management, 
together with available consultants, should review 
periodically their health service programs to determine 
how effectively health service needs are being met; and 
to determine what activities are being performed by 
nurses which could be done more economically by 
other personnel. This type of review is essential in 
all health service programs if we are to spread the 
services of the nurses we have to serve most equitably 
the community as well as industry. 


- 36 - 


3. Before hiring a nurse for their plant, manage¬ 
ment and the plant physician, together with available 
nursing consultants, should critically review the pro¬ 
posed work load and determine whether or not a nurse's 
professional skills can be fully utilized. When a small 
plant cannot effectively utilize the services of a full¬ 
time nurse, management may consider sharing the 
services of a nurse with another small plant rather 
than depleting further its community nursing resources. 

4. Studies of nursing consultation services should 
be made to determine: 

(a) What methods, techniques, and procedures 
now employed are effective in assisting the 
nurse to improve her performance, and what 
methods can be devised for sharing with other 
consultants those concepts and techniques 
which are successful. 

(b) To what extent such measures as group 
conferences, work shops, and institutes 
can be employed to give the plant nurses 
opportunity to share experience and ideas 
for providing optimum health services. 

(c) To what extent orientation programs can be 
established for the purpose of assisting the 
new nurse entering industry to function 
more effectively and with more security. 


- 37 - 







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Public Health Service Publication No. 190 



































